Defining Concierge Medicine

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According to WebMD, They’re often physicians who choose to form a private practice to limit the number of patients they’re responsible for — usually a smaller number compared to the volume of a more traditional office practice — and to minimize the amount of paperwork associated with insurance payouts. Concierge doctors can do everything a primary care physician can, including administer lab tests and conduct annual physical exams. They also typically provide diagnostic screenings and minor urgent care services like stitches or treatment for minor skin conditions. However, they can’t provide many specialized treatments or major medical procedures, like surgery. (Source: https://www.webmd.com/a-to-z-guides/what-is-a-concierge-doctor)

According to Medicare.gov, You pay 100% of the membership fee for concierge care. Concierge care is when: A doctor or group of doctors charges you a membership fee. They charge this fee before they’ll see you or accept you into their practice. Concierge care may also be called concierge medicine, retainer‐based medicine, boutique medicine, platinum practice, or direct care. When you pay this fee, you may get some services or amenities that Medicare doesn’t cover. Doctors who provide concierge care must still follow all Medicare rules: Doctors who accept assignment can’t charge you extra for Medicare-covered services. This means the membership fee can’t include additional charges for items or services that Medicare usually covers unless Medicare won’t pay for the item or service. In this situation, your doctor must give you a written notice called an “Advance Beneficiary Notice of Noncoverage” (ABN) listing the services and reasons why Medicare may not pay. Doctors who don’t accept assignment can charge you more than the Medicare-Approved Amount for Medicare-covered services, but there’s a 15% limit called the ” limiting charge.” All Medicare doctors (regardless of whether or not they accept assignment) can charge you for items and services that Medicare doesn’t cover. The membership fee is governed by the contract or agreement you sign with the doctor or doctor group. Additional state laws and consumer protections may apply. For more information, contact your state’s insurance departmentor consumer protection bureau. (Source: https://www.medicare.gov/coverage/concierge-care)

According to Forbes, For a flat monthly fee, you get unlimited office and telehealth visits that last as long as you need, as well as direct care from a doctor without worrying about copays and other charges. You also gain access to your doctor’s direct phone line for medical questions and simple diagnostic and blood tests in their office. And if you have a major health problem, your doctor coordinates specialist referrals and/or hospital care as needed. With concierge medicine, there’s no insurance or corporate health system interference—just doctors and patients. (Source: https://www.forbes.com/health/healthy-aging/concierge-medicine/)

According to Definitive Healthcare, When the concierge medicine model first appeared in the mid-1990s with Seattle-based MD2 International, it introduced the idea of “luxury medical care” and came with a price tag to match—with patients paying up to $25,000 per year for the boutique healthcare experience. What’s more, this cost was paid in addition to regular health insurance premiums and didn’t cover the costs of hospitalization or specialist consultations. Though some patients still pay a five-figure fee for their care, the average fee for membership in a concierge practice nowadays is between $1,500 and $2,400 a year—or between $125 to $200 a month. (Source: https://www.definitivehc.com/blog/what-is-concierge-medicine)

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